In an ASPE Issue Brief in early 2015, the U.S. Department of Health and Human Services defined expansion of Medication-assisted Treatment (MAT) as one of three target priority areas to combat opioid abuse in the United States. Since 2013, Vermont has employed a system known as the Hub and Spoke Model to deliver MAT services to those suffering from opioid substance abuse disorder. The hubs are seven Opioid Treatment Program (OTP) facilities, serving five regions across Vermont. Each hub is designed to treat clients with the highest needs, as well as those receiving methadone maintenance. Additionally, any service provider who is wavered to prescribe MAT medications in an Office Based Opioid Treatment Program (OBOT) would be considered a spoke provider. In December 2016 there were roughly 180 spoke prescribes in Vermont. Some of the larger spoke providers in Chittenden County include the Community Health Center of Burlington (CHCB), UVM Addiction Treatment Partners (ATP, formerly the DayOne program), and Comprehensive Obstetrics and Gynecological Services (COGS) at the UVM Medical Center.
Between December 2016 and January 2017, spoke treatment levels for Medicaid patients increased by 16%, the largest recorded increase since 2013. Since January 2017, however, spoke treatment levels have fallen to just under 600 patients, but still remain well above the average treatment level of 472. Though it is difficult to ascribe causality to any single factor, or even a number of factors, one key element to the rapid increase in treatment may be the expansion of spoke providers in Chittenden county in 2016, and one element of the decline may be the closing of Maple Leaf Treatment Center between January and February 2017. In an attempt to help alleviate the capacity bottleneck at the Howard Center Chittenden Clinic, also known as the Northwest Hub, there have been concerted efforts to increase spoke treatment capacity. As a result, spoke prescriber numbers in Chittenden County have increased from 38 to 70 between March and December 2016, an 84% increase. The increased number of prescribers may have allowed hub providers to transfer more patients to spoke levels of care within the county. Conversely, when Maple Leaf Treatment Center closed, roughly half of the patients receiving treatment there continued their treatment in Chittenden County, while the other half have received treatment from providers in neighboring counties, and may therefore no longer be reflected in Chittenden County figures.
For more information about treatment levels across Vermont, in hub and spoke settings, please refer to this Opioid Use Disorder Treatment Census and Wait List report produced by the Vermont Department of Health.